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A rare case of posttraumatic meningitis presenting with acute hydrocephalus
M Petrov1, J Samuel2, I Jordanova1
1Department of Neurosurgery, University Multiprofile Hospital for Active Treatment with Emergency Medicine N. I. Pirogov, Sofia, Bulgaria.
Abstract:
Posttraumatic meningitis is a severe complication of traumatic brain injury (TBI) that dramatically increases its mortality. Skull-base fractures increase the risk of posttraumatic meningitis. Posttraumatic hydrocephalus was encountered in 0.7 %-29 % of the patients with severe head injury. Posttraumatic hydrocephalus should be differentiated from ventriculomegaly due to brain atrophy. We present a clinical case of a 52-year-old patient after a mild TBI and a linear skull base fracture who developed acute hydrocephalus in the context of a posttraumatic meningitis within the first week after the injury. The occurrence of hydrocephalus in patients with posttraumatic meningitis is not well studied but could lead to rapid deterioration of the patient. It results from injury-induced disturbance of CSF flow either through obstruction or lack of CSF reabsorption. Factors increasing the risk of posttraumatic meningitis are - operative interventions, skull base fractures and CSF leakage. Patients with meningitis usually present with lower GCS score. The lower GCS is a harbinger of worse prognosis. Therefore, aggressive medical treatment is warranted. With this case study we show that meningitis presenting with PTH can develop rapidly over 24 h within the first week post mild head injury with basilar skull fracture. A swift response in providing timely ventricular drainage, together with an appropriate antimicrobial coverage, can greatly reduce any lasting neurological deficits and produce a good clinical outcome.
Insights
Posttraumatic meningitis, a severe traumatic brain injury complication, can rapidly cause acute hydrocephalus, even after mild head injuries with skull fractures. Prompt ventricular drainage and antibiotics are crucial for good outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Posttraumatic meningitis is a severe complication of traumatic brain injury (TBI), significantly increasing mortality.
- Skull-base fractures are a known risk factor for posttraumatic meningitis.
- Posttraumatic hydrocephalus (PTH) occurs in a variable percentage of severe head injuries and must be distinguished from other causes of ventriculomegaly.
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